What Do the Disabled Report About Their Experience with Medicare? ADL Disability and CAHPS Measures Among Medicare Fee-for-Service Beneficiaries
West, N. D., Bernard, S. L., & Eicheldinger, C. (2005, December). What Do the Disabled Report About Their Experience with Medicare? ADL Disability and CAHPS Measures Among Medicare Fee-for-Service Beneficiaries. Presented at American Public Health Association Annual Meeting, Philadelphia, PA.
Data come from the 2003 Medicare CAHPS Fee-for-Service survey, a cross-sectional national survey of 107,893 non-institutionalized respondents enrolled in the Medicare program. The regression models included two variables created from survey responses and information provided from the Enrollment Database: ADL limitation and Medicare Entitlement. Case-mix variables race, ethnicity, insurance status, and personal doctor were also added to the regression models.
In general, we found a linear relationship between extent of disability and CAHPS scores. Regardless of a beneficiary's original Medicare entitlement status, the greater the level of difficulty with ADL functioning, the lower beneficiaries rate the Medicare program and their overall health care. We found this also to be true for composite measures of beneficiaries' experiences with health care services in Medicare, particularly whether or not they received needed care and had good communication with their providers. Compared to beneficiaries with no ADL difficulty, beneficiaries with severe ADL difficulties have disproportionate scores of high dissatisfaction with the Medicare program and their overall health care, and more significant problems receiving good care in the Medicare program.
Our findings suggest that the severity of a disabling condition, as measured by ADLs, does account for variation in expectations and satisfaction in the Medicare program. While prior work demonstrated that Medicare beneficiaries whose original reason for entitlement was disability reported worse experience with their health care, this study suggests that even among these disabled elderly those who have difficulty performing activities of daily living report lower satisfaction and worse experience.